Doctors Decry Government DIKTAT

Govind Sharma
Becoming a doctor is one of the most challenging career paths one can embark upon. It requires intense hard work and perseverance before one starts to practice as a Doctor . Recently as per govt order no 141-JK(HME) of 2021 dated 25-02-21, 90 doctors out of 153 appointed medical officers who refused to join J&K govt health services, were terminated, 9 tendered resignation. Before this, 194 candidates out of 459 doctors opted not to join. So why there is waning interest in picking up the job in JK govt health services. In last 2 years, around 1169 (rough estimate ) medical officers have either resigned or terminated for not joining the service. There appear two main reasons, among others, behind this anticipated doctor drought. First is the harsh service conditions which are creating impediment in the career progression of Medical Officers and another is recruitment of medical officers in J&KHFW and lecturers in GMCs under SRO 192 dated 17-06-2020 (J&K Condition of service, pay and allowances rules).
As per policy guidelines framed in 2019 (03-HME of 2019 dated 27.05.19) , any medical officer intending to join MD/MS/DM/DNB/Fellowship training programme should have prior 3 years of service to his credit. Doctors association resented this move. But to their surprise it was later amended again to 5 years, by issuing circular 18-HME- 2020 dated 29.12.20, which frustrated the young doctors aspiring to go for specialisation courses . Medical profession is already a very long struggle with ever increasing number of national examinations, age of finishing specialization and superspecialisation is upto mid or late thirties and govt is adding hindrances in their career progression with another 5 years service rider. Medicos are likely to get these courses earlier in their career and they should be supported right in the beginning to obtain such specialist courses as and when they get these. During Post-graduation residency, a doctor goes through a very tough curriculum by being on duties lasting 30-36 hours at continous stretch swamped with patients beyond the logical human capacity. So doing post graduation in govt medical college is not an easy task at all, still doctors are begging the Govt to allow them to go for higher studies so as to acquire skills and expertise in their field. Post graduate residents are the backbone of the medical colleges, they work tirelessly day in and day out serving people. Allowing govt servants to acquire higher qualification will bring competent specialized health care providers to the society and make the peripheral health care system stronger. This shall also decrease load on tertiary care centres which is need of hour.
With the changing community needs, educational advancement, technological revolutions, health care system needs to be updated and bring a competent specialized health care provider to the society. A paradigm shift from a graduate to post graduate is the need for betterment. We have wide spread shortages in nearly all specialties. Stringent rules and regulations hinders the flexibility for opting higher education for betterment of patient care.
A Doctor’s journey starts with MBBS of 5 years duration followed by Internship of 1 year, after that one need to qualify competitive NEET-PG exam to secure a seat in post graduate courses (MD/MS/DNB) of 3 years duration. Usual time taken by average candidate to crack NEET-PG entrance is 1-2 years. Then who wish to pursue much demanding Super-speciality course, again have to compete in NEET-SS which again takes 2-3 years to prepare for the said exam so as to get into DM/Mch/DNBSS course of 3 years duration. Some after doing MD/MS donot go for Superspeciality course but may prefer to go for Senior residency or Registrarship of 3 years duration which makes them more experienced and more competent and also an eligibility for the entry level academic posts viz. Lecturer and Assistant Professor. All it takes 15-16 years of hardwork and perseverance to become a Superspecialist or equivalent Experienced doctor and govt is adding impediment in their career progression by introducing 5 years service criteria.
These unstandardized policies by administrators will ultimately lead to no availability of doctors and selection of sub-optimal quality of doctors for peripheral health care system which is evident from the fact that around 293 doctors out of 612 have refused to join or resigned in the recently concluded selection process of medical officers. New appointees are not ready to join and in-service candidates are leaving, which will ultimately lead to collapse for peripheral health care system. This is only because of new policies and riders imposed by administrative department regarding issuance of NOC for higher studies.
In India, doctor-patient ratio, working environment, long working hours, pay disparity, social accountability are various issues faced by doctors. Now, these unstandardized policies by administration has added to the stress of doctors and in future will hinder the quality of patient care.
Now with the recent amendment order issued on 29.12.20, this 5 years eligibility criteria has been introduced which makes one eligible for undergoing higher studies like MD/MS/DM after completion of 5 years service through competitive entrance exam (NEET-PG/SS) . Nobody can ensure that one can get it after 5 years, as chances of getting PG seat gets grim with each passing year. If Govt ensures that whosoever completes 5 years of service, will get a free entry into postgraduate courses after 5 years without competing in entrance, then I would welcome this step, which unfortunately it is not possible.
As we know, Health system in our state is already crippled due to shortage of Doctors, but now this void will be widened due to these wrong policies of the Health administration. Instead of bringing in reforms to attract the talented brains, govt is pushing them against wall as a result of which those who are already in service are resigning and the new appointees are reluctant to join as it hampers their career growth . Specialisation courses are merely for upgradation of skill and knowledge of doctors where in the patients are the direct beneficiaries in real sense.
Another important reason for losing interest in Govt. Machinery is the recruitment of Medical Officers and Lecturers in GMCs under SRO 192. Elaborating further, Candidates appointed under SRO 192 dated 17-06-2020 (J&K Condition of service, pay and allowances rules) are entitled to Basic salary for 2 years before they start to receive annual increments and other allowances like DA,HRA,CCA, Tpt allowances and so on. As we all know there has been always a dearth of doctors in rural areas due to certain reasons. Now, to improve the rural health delivery, Health administration has taken certain steps in the interest of patient care which are proving counter-productive. Instead of incentivising the doctors working in the remote areas so as to motivate them, govt has reduced their salary by applying SRO 192 which is devoid of any logic. It is pertinent to mention that Medical Officers in J&K Govt Health services falls in pay level 9 (52700-166700) post where as J&K Administrative services (KAS) falls in level 8 (47600-151100) but unfortunately Medical Officers and even lecturers in GMCs are being appointed under SRO 192 whereby their legitimate salary has been reduced to basic for Ist 2 years but full benefits are given to newly appointed KAS/KPS and Account services officers despite being in level 8 in pay matrix. Reason better known to the policy makers. If there are financial constraints then medical officers post should get overriding priority . Such discrimination should end in the interest of larger public interest. Why any young enthusiastic doctor will go in far flung area on half salary with a rider not to opt for higher studies before completion of 5 years service ?
Last year in UT of Ladakh, to attract the Medical Officers/Specialists to work in remote areas , Govt incentivised them by offering good salary package which ranged from 1.1 lacs to 2.3 lacs pm under NHM, against the base salary of 35-50k. Same way, if govt seriously wants to upgrade the peripheral health care, it should provide incentives to the doctors willing to work in periphery, if not, then atleast full legitimate salary should be given by removing this SRO 192.
Ironically, Medical Officers (MBBS), Broad Specialities Lecturers (MBBS+MD + 2 years experience), Superspeciality Lecturers (MBBS+ MD+DM) all are recruited in the same pay band of Level 9. There is huge pay discrepancy as compared with their counterparts in Central Govt Institution or Private sector. A Superspecialist in Corporate sector is offered minimum 3 lacs salary package per month but paid around 70k in our govt setup. Even a Senior Resident (pay band 11) in Central Govt hospital earns more than a superspeciality lecturer (Pay band 9) in our UTJK despite have additional superspecialisation.
Those medical officers who have done specialisation and superspecialisations are utilised by the Govt against the posts of Specialists ( B-Grade Consultants) at their own pay and grade. Even in Superspeciality Hospital Jammu/Srinagar, many faculty members are actually Medical Officers whose services are being utilised against the post of Superspecialist faculty and It is govt and the public at large who are getting benefitted. But the Superspecialist doctors are getting same Medical Officer salary. Instead of providing good pay and perks, govt is recruiting doctors under SRO 192 so as to pay them much less than what even a medical officer reasonably deserves.
More qualified doctors can serve the society in a better way. 5 years in-service eligibility criteria for study leave should be reduced to 2 years so as to make one eligible for undergoing higher study courses .
Provision of Extra-Ordinary leave or No-pay leave maximum for 3 years after 1 year of service for higher study/training purposes.
Medical Officers posted in Rural Area should be paid Special allowances so as to encourage them in work in rural areas instead of curbing their career growth and withholding their allowances. Presently Medical Officers serving in urban cities has total salary more than those working in rural areas.
Promotion avenues: In Central Govt Service , Medical officers get ist promotion after 4 years of service with pay upgradation, 2nd at 5 years , 3rd after 4 years and then 4th after 7 years of service. But in our state, promotions are due after 10 years, 15 and 20 years. That too is not done timely.
Extra-incentives for acquiring Higher Degrees which are in the interest of patient care.
Posts of Medical Officers and above should be kept outside the ambit of SRO 192.
After incorporating all these, 3 year Service-Bond can be introduced for those who want to go for higher studies before completion of 2 years.
The flawed policies curbing the skill upgradation of medicos, need to be re-examined as it would lead to brain drain, which will affect the ailing healthcare of J&K adversely.